[Results of video-assisted technologies in colorectal surgery]. / Rezul'taty vnedreniia éndovideokhirurgicheskikh tekhnologii v kolorektal'noi khirurgii.

AIM: To analyze immediate outcomes of 286 laparoscopic and robot-assisted interventions on the colon and rectum. MATERIAL AND METHODS: There were 256 (89.51%) laparoscopic and 30 (10.49%) robot-assisted procedures. 233 (81.46%) operations were performed for rectum and colon cancer. Postoperative complications after colon cancer surgery were revealed in 11.11%, including anastomosis failure in 2.08% of cases. Postoperative complications after rectal cancer surgery occurred in 32.58% of cases including anastomosis failure after anterior rectectomy in 11.67%. CONCLUSION: Robot-assisted surgery is not advisable for colon diseases according to price-effectiveness ratio due to available laparoscopic approach. Preventive intestinal stoma in endoscopic low and ultra-low anterior rectal resection allows you to avoid clinically significant inconsistency of colorectal anastomosis. Laparoscopic procedure should be performed with Contour stitching-cutting device in low and ultra-low anterior rectal resection if there is technical complexity of one-stage rectum intersection below the tumor. Robot-assisted operations for rectal cancer have advantages due to three-dimensional imaging and better orientation, greater freedom of manipulation in confined spaces, and simplicity of lymphadenectomy.

[Endovascular interventions in true and false aneurysms of hepatic, splenic and renal arteries].

A false aneurysm of visceral arteries is a life-threatening pathology sufficiently difficult to treat. Open operations are characterised by a large scope, considerable surgical injury and accompanied by a high rate of serious complications. The development of the technology of superselective catheterization of blood vessels, creation of specialized microcatheters, glue composites and various types of spirals made it possible to treat this severe pathology without resorting to open operations. The work deals with a brief literature review concerning epidemiology, methods of diagnosis and treatment of pseudoaneurysms of visceral arteries, followed by presenting three clinical case reports concerning successful treatment of posttraumatic false aneurysms of the right hepatic and splenic arteries, as well as an aneurysm of the renal artery. Both immediate and remote results of endovascular interventions in these patients are followed up, demonstrably showing possibilities of endovascular technologies in treatment of the pathology involved.

SP-D-dependent regulation of NO metabolism in lipopolysaccharide-stimulated peritoneal macrophages.

This work was designed to study the role of surfactant protein D in the regulation of NO synthesis by "non-alveolar" microphages. We evaluated whether the effects of surfactant protein D depend on the phenotype of macrophages. In the absence of surfactant protein D, the LPS-induced iNOS response was shown to decrease in macrophages of native and proinflammatory phenotypes by 30%, and in macrophages of the antiinflammatory phenotype (by 63%). Under the influence of lipopolysaccharide in high doses (500 ng/ml), NO(2)*- production by mouse macrophages without surfactant protein D was reduced in native cells (by 25%), but increased in proinflammatory (by 40%) and antiinflammatory phenotypes (by 12% compared to mouse macrophages with surfactant protein D). Our results suggest that surfactant protein D is involved in the immune response in the whole organism, but not only in the lungs. The effect of surfactant protein D depends on the phenotype of macrophages.

Inversion of stress response reprogramming phenomenon in lipopolysaccharide-stimulated alveolar macrophages.

The stress response and NO production in reprogrammed proinflammatory or antiinflammatory alveolar macrophages were studied after lipopolysaccharide treatment. Experiments with macrophages not containing HSP70 showed that lipopolysaccharide in a dose of 500 ng/ml induced stress response in cells with the proinflammatory phenotype (as distinct from an antiinflammatory phenotype). The stress response was not observed in HSP70-containing lipopolysaccharide-stimulated proinflammatory macrophages, but occurred in cells with antiinflammatory phenotype. Hence, the presence of HSP70 in alveolar macrophages results in the inversion of the phenomenon of reprogramming of the stress response. Independently on the phenotype, stimulation with lipopolysaccharide was accompanied by a 60-70% increase in NO production by macrophages not containing HSP70. However, NO production by HSP70-containing macrophages did not increase in response to lipopolysaccharide treatment. Our results indicate that reprogramming of the cell response in macrophages does not concern the system for NO synthesis. HSP70 prevents the lipopolysaccharide-induced activation of NO synthesis in alveolar macrophages.

Intracellular and extracellular NO differentially modulates the stress response and apoptosis in macrophages exposed to the influence of biological or physical factors.

We studied the role of extracellular and intracellular NO in the regulation of the stress response and apoptosis in macrophages of proinflammatory and antiinflammatory phenotypes under the influence of S. aureus and heat shock. Blockade of extracellular nitric oxide synthesis in cells with antiinflammatory phenotype inhibited the stress response induced by S. aureus and heat shock. The decrease in extracellular nitric oxide concentration around antiinflammatory macrophages potentiated the stress response induced by S. aureus, but had no effect on the stress response induced by heat shock. Hence, intracellular NO mediates the stress response induced by S. aureus and heat shock, while extracellular NO inhibits the stress response induced by S. aureus, but has no effect on the stress response induced by heat shock. In cells with antiinflammatory phenotype, intracellular NO plays an antiapoptotic role. S. aureus and heat shock did not cause apoptosis in macrophages with proinflammatory phenotype, while intracellular NO did not play a role in antiapoptotic activity of the proinflammatory phenotype. Extracellular NO synthesized by macrophages protects these cells from apoptosis induced by S. aureus and heat shock.

Effects of ion association of lipophilic quaternary ammonium salts in ion-exchange and potentiometric selectivity.

It has been found experimentally and substantiated theoretically that the anion-exchange selectivity in water-lipophilic quaternary ammonium salts (QAS) toluene solutions systems as well as the potentiometric selectivity of plasticized PVC membranes containing QAS, are strongly influenced by ion association. In particular, it has been demonstrated that varying the steric accessibility of QAS exchange center is a powerful tool for the selectivity control. The experimental values of the selectivity change caused by variations in the QAS exchange center steric accessibility were about 3 orders of magnitude when the single-charged ions were exchanged for the single-charged ones and more than seven orders when double-charged ions were exchanged for the single-charged. The above effects have also been observed for the potentiometric selectivity of QAS-based PVC membranes and, to some extent, for the potentiometric selectivity of the neutral anion carrier-based membranes doped by QAS to provide anion permselectivity. This fact is of immediate practical interest for the development of ISE with improved selectivity. The obtained results allow to revise the generally accepted idea of QAS as "nonselective" ion-exchangers and to suggest specific ways for controlling the ion-exchange and potentiometric selectivity using the ion association as a tool.

[Anesthesia in the early postoperative period in patients who had undergone extensive surgical interventions on the colon with plastic repair]. / Anesteziia v rannem posleoperatsionnom periode u bol'nykh, perenesshikh obshirnye khirurgicheskie vmeshatel'stva na tolstoi kishke s élementami plastiki.

Reconstructive plastic (n = 24) and repair operations (n = 23) on the colon were performed in 47 patients at Coloproctology Research Center (Moscow). The patients were divided into 2 groups administered different anesthesias and postoperative analgesias: total intravenous anesthesia (TIA) and combined epidural anesthesia (CEA). Adequate analgesia by CEA and early activation of patients after the operation promoted earlier (by 2 days) recovery of the motor function of the intestine than after TIA and traditional intramuscular analgesia with a narcotic analgetic. CEA ensured complete blocking of nociceptive pulsation and neurovegetative protection a with lower doses of narcotics during the postoperative period and can be used in this type of operations and postoperative management. CEA prevented gastrointestinal pareses, improved microcirculation and metabolic processes at the zone of intervention, and decreased the incidence of postoperative complications.